The case of the coughing patient
By Dr. Ami Neuberger
Think that you are a doctor in a rural community. You see patients in your office and occasionally perform house calls. Think of a 55 year old patient who has a fever. She has been ill for less than 48 hours, feels unwell and has a cough. You are unsure whether she has a bacterial infection, whether there is a pneumonia, whether she should be treated with antibiotics, and whether she should be admitted.
If this patient were examined in an emergency department or a high-volume community healthcare center, the first test to order would have been a complete blood count.
If the patient would have leukocytosis (high number of white blood cells), and a high number of neutrophils (a type of white blood cells) – bacterial infection would be much more probable. Antibiotics would be prescribed. On the other hand, if a low number of white blood cells would have been found, and these would be predominantly lymphocytes (another type of white blood cell) – a viral infection is more likely and perhaps the use of antibiotics could be avoided.
Extremely high or low white blood cells counts (extreme leukocytosis or neutropenia) would attest to the severity of this probable infection, and may make the decision to admit this patient easier and quicker.
But… complete blood counts are unavailable for house visits today, and for on-site performance of such testing, either shipment to a central laboratory would be needed (and be too time and labor consuming), or some laboratory equipment (expensive, space occupying) would be needed.
Role of RevDx in this patient management
RevDx allows you to perform a complete blood count without a central laboratory, without expensive equipment, without having to wait for results longer than 10 minutes, without the need for electricity, and without the need to perform venipuncture.
Using capillary blood, automated staining, advanced optics, and machine-learning based image analysis, results of this test would be available almost immediately, whether in the patient’s home, or in your office. For the doctor the RevDx system would add convenience, and a higher degree of certainty when making decisions about patients with fever. For the patient – the difference between unnecessary antibiotic treatment, and immediate referral to an urgent admission – would seem even more important.